Corradino, we have a problem

No less than 13 prisoners have died while serving time at Corradino Correctional Facility over the past three years

Most probably, the number of attempted suicides is even greater than that. This ever growing problem had induced government to appoint a Board to look into the correctional services' internal procedures. Prison is a process, a succession of imprisonments. At first, it operates only on a physical level, restricting one’s movement. Later, it extends to the psychological plane, encompassing one’s very perception. Eventually, an inmate comes to exclude all thoughts, all visions of the free world.

Suicide is a common cause of concern in prisons both in Malta and abroad. It will never be eradicated but the pressing problem is the fact that it is on the rise. We know for sure that suicide in prison is multifactorial, with contributing factors that include medical and mental health issues as well as those involving family, lack of purposeful activity and conditions of the specific prison environment, as well as the stress of adjusting to incarceration. Within the prison environment, psychological distress about bullying, conflicts with other inmates, disciplinary actions by prison staff and hearing bad news regarding family or legal matters exacerbate the stress of imprisonment, where feelings of hopelessness and the sudden narrowing of future prospects lead to desperation and suicidal thoughts. A number of non-environmental factors also contribute to increased risk for suicide in prison, including poor social and family support, a history of mental illness and/or emotional problems, withdrawal from substance abuse and a history of prior suicide attempts.

Juvenile offenders, especially those who have never been incarcerated before, are particularly vulnerable to distress over separation from family and fears of the future, which, coupled with lessened coping skills and naturally excessive emotional responses, puts them at the highest risk for inmate suicide.

In spite of the implementation of all possible known screening programmes and suicide prevention strategies at Corradino, there is still a long way to go. Correctional facility officials should never conclude that an inmate suicide was not preventable unless they have demonstrated that their facility initiated and maintained a comprehensive suicide prevention programme. Perhaps it is time to revisit the essential features of an effective suicide prevention programme and one augurs that eventually, the government-appointed Board will come up with a number of effective recommendations and proposals.

Physical prevention strategies, including suicide-resistant housing and clothing, as well as restrictions and careful supervision during showers, telephone calls and visiting hours, commensurate with risk level, one presumes, are in place. Over and above that, the essential features of an effective suicide prevention programme should include annual training and retraining of all correctional, medical and mental health staff, evaluations of inmates at intake and ongoing screening/assessment for suicide risk as well as procedures for effective communication about prisoner state of mind and suicide risk between outside entities and correctional facilities and between facility staff and the suicidal inmate.

Suicide has become the single most common cause of death in our correctional settings. Corradino Correctional Facilities are responsible for protecting the health and safety of their inmate population and the failure to do so can be open to legal challenge. Further fuelled by media interest, a suicide rate spike in our correctional facility can easily escalate into a political scandal as it already seems to be transforming itself. Everything seems to be indicating that the current approach is not effective in preventing these deaths. Moreover, suicidal behaviour by custodial inmates means a stressful event for officers and other prisoners faced with it. Therefore, the provision of adequate suicide prevention and intervention services is beneficial to the prisoners in custody, as well as to the institution in which the services are offered.

Many a time it has been recognised that our CCF environment can exacerbate mental ill health, heighten vulnerability and increase the risk of self-harm and suicide. Consequently, a multilevel approach, incorporating risk factors related to the prison environment alongside individual-level risk factors, may be necessary to reduce these preventable deaths in custody. Up to a while ago, I used to think that the increased rate of overcrowding at Corradino might be associated with the rising rate of prisoner suicide. However, today I am having second thoughts. I can see no logical association between the rate of overcrowding and the rate of prisoner suicide. True, overcrowding necessitates that cells will have to temporarily accommodate more than one inmate. Yet having a cellmate can be a protective factor against suicide, perhaps due to social interaction or, if a suicide attempt

occurs, having someone there who can alert staff and/or intervene quickly.

Furthermore, I am inclined to think that only offenders that have committed more serious or violent offences are imprisoned, while those charged with minor or non-violent offences are given community sentences or other types of non-custodial punishments and sentences as contemplated by our laws. As such, our prisoner population should include a large proportion of people who have committed more serious or violent offences and, most likely, a large proportion of people suffering from mental illness. Having committed a serious or violent offence can be associated with an increased risk of suicide and, similarly, evidence of mental illness can be linked to increased suicide risk.

Although the above may provide a useful insight into individuallevel risk factors, less is known about how the prison environment may play a role in the increase of suicide risk. Therefore, I contend, we will need to also investigate a number of factors related to the prison environment. I am sure that the appointed Board will not ignore this aspect. Inmate suicide involves a more complex combination of risk factors. Of course, research into risk factors alone will not be enough to reduce the rate of prisoner suicides. A national strategy that aims to prevent suicide in our Facility needs to be implemented effectively, informed by the evidence.